| NPI | 1922416114 |
|---|---|
| Former Name | KYLE VINING HOLMBERG |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS043579) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 1856548) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2022-08-03 |