| NPI | 1952622433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413740) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038328) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2014-04-22 |