| NPI | 1093971780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: MD 05880) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 05880) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2008-08-01 |