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 |