| NPI | 1518190800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413862) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN013968) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2021-05-20 |