| NPI | 1649530569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 14844) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401413349) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2012-05-24 |