| NPI | 1306906763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000014) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401005794) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2025-09-11 |