| NPI | 1851773220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21282) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 11755248-9921) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2023-09-11 |