| NPI | 1417085838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS035348) |
| Additional Taxonomies | 122300000X Dentist (Licence: WY 938) |
| 122300000X Dentist (Licence: NE 5947) | |
| 122300000X Dentist (Licence: IN 12007599A) | |
| 122300000X Dentist | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2007-07-08 |