| NPI | 1689011009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 043800380) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414078) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2018-07-06 |