| NPI | 1750583738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414337) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6215-015) |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2015-08-11 |