| NPI | 1700114097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14719) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412323) |
| 122300000X Dentist (Licence: DC DEN1001069) | |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2024-11-07 |