| NPI | 1760544993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411246) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036561L) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-12-25 |