| NPI | 1386158673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401416884) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD 16587) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2021-07-19 |