| NPI | 1316100639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414354) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037550) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2015-08-10 |