| NPI | 1477700250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 008315) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412072) |
| 122300000X Dentist (Licence: PA DS038580) | |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2013-04-15 |