| NPI | 1407098197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401410947) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL 15251) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2009-03-27 |