| NPI | 1316109606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412770) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8641) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2022-05-31 |