| NPI | 1033224209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12684) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 047744-1) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2023-02-01 |