| NPI | 1982982252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401413261) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC DEN1001029) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2015-05-20 |