| NPI | 1740514413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412645) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18874) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2009-12-09 |