| NPI | 1760045819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401416544) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS043570) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2022-05-18 |