| NPI | 1184105330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17153) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041945) |
| Enumeration Date | 2018-08-26 |
| Last Update Date | 2021-07-28 |