| NPI | 1013953512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 13609) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1000674) |
| 1223G0001X Dentist, General Practice (Licence: NY 051357) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2013-10-04 |