| NPI | 1962527150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN22332) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036954) |
| 122300000X Dentist (Licence: RI DEN03029) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2012-06-14 |