| NPI | 1023080710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 8569) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411263) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2013-01-17 |