| NPI | 1154499598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15755) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410408) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2024-02-29 |