| NPI | 1750325361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401006304) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000026) |
| 122300000X Dentist (Licence: VA VA0404006304) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-08-21 |