| NPI | 1699901157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 14727) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 24437) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2024-03-26 |