| NPI | 1932362498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4512) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411873) |
| Enumeration Date | 2008-07-05 |
| Last Update Date | 2008-09-09 |