| NPI | 1275989220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 16753) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857175) |
| 122300000X Dentist (Licence: PA DS039965) | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2021-11-24 |