| NPI | 1225198476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 13645) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13645) |
| 1223G0001X Dentist, General Practice (Licence: PA DS-036317) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-11-17 |