| NPI | 1134371966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000767) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054051) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2024-04-05 |