| NPI | 1417107160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD -14166) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1000730) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2024-03-05 |