| NPI | 1861525958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 12639) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 8586) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |