| NPI | 1396869491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 7104) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 7104) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-08-14 |