| NPI | 1407973274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11703) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MD 11703) |
| 1223G0001X Dentist, General Practice (Licence: PA DS028893L) | |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2021-10-26 |