| NPI | 1689917619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC 1000584) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411634) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2013-03-28 |