| NPI | 1083688147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410785) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13147) |
| 1223G0001X Dentist, General Practice (Licence: NY 049343-1) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2007-07-08 |