| NPI | 1265732531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 60478) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22di02445200) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2013-10-25 |