| NPI | 1093201782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010479) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059696) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2020-02-19 |