| NPI | 1609987882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 10964) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 10964) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-11-11 |