| NPI | 1023571726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401416893) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16949) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2021-05-31 |