| NPI | 1013051937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 401006998) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 401006998) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401006998) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2025-04-17 |