| NPI | 1568683035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412047) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM 1811) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2010-02-09 |