| NPI | 1982886438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 55855) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: RI DEN03249) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2015-02-25 |