| NPI | 1770713653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000958) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037720) |
| 122300000X Dentist (Licence: VA 0401412930) | |
| Enumeration Date | 2009-07-25 |
| Last Update Date | 2016-07-19 |