| NPI | 1437171790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03069) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 037677-1) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2010-01-22 |