| NPI | 1073712451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 009982) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 048020-1) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2011-09-21 |