| NPI | 1336204650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI 2830) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 050328-1) |
| 122300000X Dentist (Licence: MA 21309) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |