| NPI | 1003144346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413033) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14671) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2022-03-21 |