| NPI | 1073775896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 13028) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050191) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2022-11-30 |