| NPI | 1588632418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415440) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 11578) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-09-20 |