| NPI | 1316059520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 1899) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 16012) |
| 122300000X Dentist (Licence: OH 15277) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2015-06-17 |