| NPI | 1598735847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410762) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN013870) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2019-08-30 |