| NPI | 1780985887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412902) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412902) |
| Enumeration Date | 2010-11-06 |
| Last Update Date | 2023-07-19 |