| NPI | 1427064773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 15142) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS029317L) |
| 122300000X Dentist (Licence: NJ 22D101941400) | |
| 122300000X Dentist (Licence: TX 0022019) | |
| 122300000X Dentist (Licence: WI 4823-015) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2012-08-27 |