| NPI | 1710960620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57211) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035846) |
| 122300000X Dentist (Licence: AZ D6933) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2013-04-18 |