| NPI | 1073689204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 016.0133972) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21855) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2022-06-06 |