| NPI | 1417911330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN02968) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035454) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2009-11-13 |