| NPI | 1881982833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2015010832) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057053) |
| 122300000X Dentist (Licence: PA DS038776) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2017-11-14 |