| NPI | 1407298706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401414100) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001297) |
| Enumeration Date | 2013-07-27 |
| Last Update Date | 2015-12-14 |