| NPI | 1720295009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 21050) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 004430) |
| 122300000X Dentist (Licence: RI DEN02924) | |
| 122300000X Dentist (Licence: NY 052591-1) | |
| 122300000X Dentist (Licence: OH 30-022317) | |
| 122300000X Dentist (Licence: PA DS036764) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |