| NPI | 1023033768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 23293) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050732) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2010-06-04 |