| NPI | 1174721781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416360) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DL12092) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2025-10-21 |