| NPI | 1942795307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416096) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: VA 0401416096) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2021-08-05 |