| NPI | 1407913585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410270) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 401410270) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2021-07-15 |