| NPI | 1962548297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: SC 4276) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 47828) |
| 122300000X Dentist (Licence: AZ 6137) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-12-05 |