| NPI | 1184694648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8124) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 048668-1) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2026-09-11 |