| NPI | 1659385367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413573) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018597) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2014-08-28 |