| NPI | 1407161458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412931) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14622) |
| Enumeration Date | 2010-08-15 |
| Last Update Date | 2010-08-15 |