| NPI | 1821288317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411627) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 13922) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2021-04-09 |