| NPI | 1619966587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VT 016.0002179) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VT 016-0002179) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2014-12-17 |