| NPI | 1467893636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415518) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 151030) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2018-09-30 |