| NPI | 1093967010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14130) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412202) |
| 122300000X Dentist (Licence: DC den1000737) | |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2008-10-21 |