| NPI | 1427059674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13158) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN29087) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2026-02-27 |