| NPI | 1780652370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008544) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11758) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2024-01-05 |