| NPI | 1023272531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2011013934) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 60918) |
| 1223G0001X Dentist General Practice (Licence: IL 019027929) | |
| 1223G0001X Dentist General Practice (Licence: MD 14777) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2012-02-08 |