| NPI | 1932227121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 55459) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NV 4806T) |
| 1223G0001X Dentist General Practice (Licence: TX 21544) | |
| 1223G0001X Dentist General Practice (Licence: NJ DI 020598) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2010-01-20 |