| NPI | 1073736377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411564) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC 1000489) |
| 1223G0001X Dentist, General Practice (Licence: NY 0513531) | |
| 1223G0001X Dentist, General Practice (Licence: MD 13576) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |