| NPI | 1124125885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 041638-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ AZ2888) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2022-08-24 |