| NPI | 1134310782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 401005980) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 401-0055980) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2023-09-15 |