| NPI | 1336373075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000890) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: MD 14410) | |
| 122300000X Dentist (Licence: VA 0401412789) | |
| Enumeration Date | 2009-05-10 |
| Last Update Date | 2011-10-04 |