| NPI | 1932495736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15807) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855671) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2015-11-12 |