| NPI | 1629567284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 17227) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC DEN1001883) |
| 1223G0001X Dentist General Practice (Licence: VA 0401416443) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2020-11-07 |