| NPI | 1134615321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401416612) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10882457-9922) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2019-07-02 |