| NPI | 1558625954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401419316) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15413) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2026-06-11 |