| NPI | 1619018009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 13018) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410839) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-09-25 |