| NPI | 1376761502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410170) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000007588) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |