| NPI | 1184732216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412094) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101243951) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000243) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2009-06-30 |