| NPI | 1538509393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 10212) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC 5095) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2013-06-26 |