| NPI | 1275507774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9469) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 2619) |
| 122300000X Dentist (Licence: NY 056541) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-05-28 |