| NPI | 1366964884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 16900) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS041461) |
| 1223G0001X Dentist General Practice (Licence: DC DEN2000140) | |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2022-06-08 |