| NPI | 1194051466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412188) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14184) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2013-05-16 |