| NPI | 1922193754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 18373) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 21177) |
| 122300000X Dentist (Licence: VA 0401418820) | |
| 1223G0001X Dentist, General Practice (Licence: CA 46321) | |
| 1223G0001X Dentist, General Practice (Licence: FL 21177) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2025-03-11 |