| NPI | 1942270954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0411000064) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 15263) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-03-22 |