| NPI | 1538216361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701003769) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008181) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |