| NPI | 1376523076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0428000093) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401006500) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000093) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2011-08-18 |