| NPI | 1134527781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414708) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15762) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2018-03-17 |