| NPI | 1467631119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 5458) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 2296) |
| 122300000X Dentist (Licence: NY 30212) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-30 |