| NPI | 1013564442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16952) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416951) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2023-10-16 |