| NPI | 1336347343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411901) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D11898) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2022-10-17 |