| NPI | 1861198251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418288) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D.6982-C1) |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2023-02-07 |