| NPI | 1871745307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14280) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1000762) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2020-07-07 |