| NPI | 1639139025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401007160) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0401-007160) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2024-02-29 |