| NPI | 1992259998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415365) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401415365) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |