| NPI | 1184286916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24198) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 061347) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2023-01-03 |