| NPI | 1124038997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 09834) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 14299) |
| 1223G0001X Dentist, General Practice (Licence: FL DN14299) | |
| 1223G0001X Dentist, General Practice (Licence: NY 50710) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2017-10-25 |