| NPI | 1245611722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15934) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11278) |
| 1223G0001X Dentist, General Practice (Licence: FL DN 21251) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2022-07-15 |