| NPI | 1093971194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58857) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 654) |
| 122300000X Dentist (Licence: NY 054562-1) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2011-11-21 |