| NPI | 1295022192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856494) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60407) |
| 122300000X Dentist (Licence: FL DN22096) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2016-12-30 |