| NPI | 1265415996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS006850) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD MD06299) |
| 122300000X Dentist (Licence: NY 032522) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2007-07-08 |