| NPI | 1245246636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411807) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS035638) |
| 1223G0001X Dentist, General Practice (Licence: MD 13231) | |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1000436) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-09-12 |