| NPI | 1114448826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17357) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858161) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2024-06-18 |