| NPI | 1073939997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401-414350) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015607) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2020-09-03 |