| NPI | 1144337171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053713-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22245) |
| 122300000X Dentist (Licence: CA 56797) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2009-08-24 |