| NPI | 1427291277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 41827) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1000553) |
| 122300000X Dentist (Licence: NY 051929-1) | |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-04-09 |