| NPI | 1023340551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 13513) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 047861-1) |
| 1223G0001X Dentist General Practice (Licence: NY 047861-1) | |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2024-03-03 |