| NPI | 1679656730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 047142-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12010905A) |
| 122300000X Dentist (Licence: PA DS030266L) | |
| 122300000X Dentist (Licence: MA 21260) | |
| 122300000X Dentist (Licence: ME 3760) | |
| 122300000X Dentist (Licence: NJ 22DI02018700) | |
| 122300000X Dentist (Licence: VT 016-0002234) | |
| 122300000X Dentist (Licence: CT 8567) | |
| 122300000X Dentist (Licence: NH 3446) | |
| 122300000X Dentist (Licence: RI DEN02865) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2015-08-18 |