| NPI | 1720148786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007772) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0401007772) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2014-09-30 |