| NPI | 1033523154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414726) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15554) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2017-03-07 |