| NPI | 1023090727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401006019) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 401006019) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401006019) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0401006019) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2022-03-02 |