| NPI | 1972049237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN22479) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030959) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2023-08-17 |