| NPI | 1689894743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 11905) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13447) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2007-07-08 |