| NPI | 1659614410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11991) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC 1001256) |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2018-05-07 |