| NPI | 1881382885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD.10923) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN123282) |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2024-08-12 |