| NPI | 1972543957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008741) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008741) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-02-13 |