| NPI | 1073771630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 054358-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041390) |
| 1223G0001X Dentist, General Practice (Licence: GA DN013658) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS041390) | |
| 1223G0001X Dentist, General Practice (Licence: MD 15611) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2021-07-06 |