| NPI | 1144236100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000177) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: VA 0438000177) |
| 122300000X Dentist (Licence: VA 0401007897) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2017-11-29 |