| NPI | 1356497143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008085) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410475) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401411204) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |