| NPI | 1740509678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20062) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413846) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2022-05-16 |