| NPI | 1821227620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 14460) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401412797) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2016-12-27 |