| NPI | 1326499807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 041415209) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10373) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-06-27 |