| NPI | 1790929065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413836) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25086) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2022-11-29 |