| NPI | 1811071871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 401008616) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 041008616) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-12 |