| NPI | 1740322049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 008359) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CT 05006) |
| 124Q00000X Dental Hygienist (Licence: CT 005913) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |