| NPI | 1225266430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0447000045) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414467) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-07-21 |