| NPI | 1245453281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA VA 8962) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0801004962) |
| 122300000X Dentist (Licence: NC 9478) | |
| 122300000X Dentist (Licence: DC 1000741) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-01-06 |