| NPI | 1710274204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61686) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038241) |
| 122300000X Dentist (Licence: NV 7024) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2019-04-09 |