| NPI | 1508404518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16537) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23088) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2019-12-20 |