| NPI | 1598993768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 016.0098106) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7778) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2022-04-27 |