| NPI | 1447301452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411267) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13837) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2018-03-17 |