| NPI | 1609974328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 046156-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019275) |
| 122300000X Dentist (Licence: NH 03515) | |
| 122300000X Dentist (Licence: IN 12010806A) | |
| 122300000X Dentist (Licence: OH 30-021538) | |
| 122300000X Dentist (Licence: PA D5031602L) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |