| NPI | 1407990252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 12266) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401008909) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2023-07-31 |