| NPI | 1124091608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6045) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 029492) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2019-06-28 |