| NPI | 1053749119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001312) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414224) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2013-10-28 |