| NPI | 1972948560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413549) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041473) |
| 122300000X Dentist (Licence: CA 61885) | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2022-07-21 |