| NPI | 1124154844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 14107) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052611-1) |
| 1223G0001X Dentist, General Practice (Licence: PR 2540) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-09 |