| NPI | 1053416685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401006110) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401-006110) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-08-11 |