| NPI | 1720311178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16566) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855281) |
| 1223G0001X Dentist, General Practice (Licence: RI 03054) | |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2018-07-24 |