| NPI | 1588040547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 016.0134138FCTY) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VT 016.0114201) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2022-11-10 |