| NPI | 1891813358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 401410740) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 401102428) |
| 1223G0001X Dentist, General Practice (Licence: VA 401410257) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |