| NPI | 1275845703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000884) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17975) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2024-06-06 |