| NPI | 1659519924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 10007) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT585) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2024-03-21 |