| NPI | 1720064611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 10782) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008125) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2022-07-21 |