| NPI | 1588746093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 401006786) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401006786) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2013-04-30 |