| NPI | 1811017643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DI014621) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401411236) |
| 122300000X Dentist (Licence: OH 30.023649) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2012-03-14 |