| NPI | 1386995652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414136) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039441) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2024-05-15 |