| NPI | 1447673298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 154457) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401414213) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2022-12-11 |