| NPI | 1720633282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24839) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600292) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2021-09-02 |