| NPI | 1154619120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417240) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 26557) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2022-10-13 |