| NPI | 1598729261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401005671) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000052) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2008-02-19 |