| NPI | 1144715533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17317) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11438) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-04-13 |