| NPI | 1841622719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 4050) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: WV 4050) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2013-08-02 |