| NPI | 1104801604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 051354) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT 2274) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2008-10-20 |