| NPI | 1134359474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D 7856) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412561) |
| 122300000X Dentist (Licence: PA DS037898) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-08-24 |