| NPI | 1326237173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DC 3734) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD LC300618) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2016-01-19 |