| NPI | 1477818979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MD 4520) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 4520) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |