| NPI | 1912947094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401006567) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 6567) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401006567) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2016-06-16 |