| NPI | 1225017338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 12545) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: RI DEN03453) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2025-11-11 |