| NPI | 1407409444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416600) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2024-08-27 |