| NPI | 1528638384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 18551) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VT 016.0134023) |
| 1223G0001X Dentist General Practice (Licence: NH 04711) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2025-06-17 |