| NPI | 1790843282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008927) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401008924) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2024-05-30 |