| NPI | 1700987641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401006982) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 6982) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-04-14 |