| NPI | 1063689164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401418193) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA 035771) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2024-10-02 |