| NPI | 1740583665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 10394) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD D31454) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN5277) | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |