| NPI | 1821544701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415331) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16032) |
| 122300000X Dentist (Licence: DC DEN1001642) | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2018-03-17 |