| NPI | 1114273430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 28871) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60885) |
| 122300000X Dentist (Licence: PA Ds039601) | |
| 122300000X Dentist (Licence: IA DDS-09265) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2016-01-27 |