| NPI | 1750995353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17126) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 00000) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |