| NPI | 1194151449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415268) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02545800) |
| 122300000X Dentist (Licence: IL 019029670) | |
| 122300000X Dentist (Licence: NH 04040) | |
| 122300000X Dentist (Licence: FL DN20358) | |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2018-06-06 |