| NPI | 1073630570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 12947) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN15408) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-07-20 |