| NPI | 1174530851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008900) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA va 8900) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2012-07-13 |