| NPI | 1497196372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415164) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001615) |
| 122300000X Dentist (Licence: MD 15908) | |
| 122300000X Dentist (Licence: MA DN19948) | |
| 122300000X Dentist (Licence: ME DEN4097) | |
| 122300000X Dentist (Licence: VT 016-0002134) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2018-12-12 |