| NPI | 1114132552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 6913) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 6913) |
| 122300000X Dentist (Licence: WV 2729) | |
| 1223G0001X Dentist, General Practice (Licence: WV 2729) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2022-08-02 |