| NPI | 1881602795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DENRI2472) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA MA18466) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |