| NPI | 1609091354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 03155) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 3155) |
| 1223G0001X Dentist, General Practice (Licence: PA DS030563L) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30.021251) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-04-06 |