| NPI | 1932458007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413725) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15176) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1001170) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2017-04-10 |