| NPI | 1861458218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411806) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 13610) |
| 122300000X Dentist (Licence: PA DS035840) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2008-07-05 |