| NPI | 1205909652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN4636) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401008527) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |