| NPI | 1003038928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 8517) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008317) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN4236) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-05-05 |