| NPI | 1215299896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413612) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19752) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2024-04-08 |