| NPI | 1386667178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 12447) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 19652) |
| 122300000X Dentist (Licence: DC DEN5978) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2017-04-06 |