| NPI | 1669876009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 15343) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC 1001336) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2014-10-14 |