| NPI | 1225479785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401416324) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 62542) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2019-07-22 |