| NPI | 1225445182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 16224) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS040105) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2024-05-16 |