| NPI | 1740241637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0411000020) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL 7750) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2007-07-08 |