| NPI | 1336158963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007755) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 041007755) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-06-28 |