| NPI | 1922210376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 10812) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 10812) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2025-09-11 |