| NPI | 1477613818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401006868) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0438000013) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2013-06-09 |