| NPI | 1386710812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 19917) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 046211) |
| 122300000X Dentist (Licence: HI 2222) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |