| NPI | 1447362652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 1245) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME 2419) |
| 122300000X Dentist (Licence: NY 26334) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |