| NPI | 1265574685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11379) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC 5474) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-12-22 |