| NPI | 1902980279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 401410135) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53314) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-07-21 |