| NPI | 1033402664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14980) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413803) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2019-05-10 |