| NPI | 1639328677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019028483) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 048817-1) |
| 122300000X Dentist (Licence: IN 12011569A) | |
| 122300000X Dentist (Licence: NJ 22DI02373800) | |
| 122300000X Dentist (Licence: PA DS036424) | |
| 122300000X Dentist (Licence: MA DN20160) | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2014-10-23 |