| NPI | 1366733461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15175) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1001339) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2016-05-15 |