| NPI | 1225531957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17043) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416686) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1002039) | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2024-07-25 |