| NPI | 1396322517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417315) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 17064) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1002171) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2021-03-24 |