| NPI | 1821071184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9843) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 51225) |
| 122300000X Dentist (Licence: NJ 22DI0314100) | |
| 122300000X Dentist (Licence: TX 18326) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2010-04-02 |