| NPI | 1437212826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008847) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 12296) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-02-06 |