| NPI | 1528275849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 13793) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD MD13793) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-05-29 |