| NPI | 1144485889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PR 2899) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054895-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2016-10-24 |