| NPI | 1649591918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15446) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038337) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2019-07-04 |