| NPI | 1073792164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413886) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 56484) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2016-03-03 |