| NPI | 1376903443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10592) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2022-07-21 |