| NPI | 1134413446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 14927) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412907) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2021-09-27 |