| NPI | 1417169715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11937) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008267) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |