| NPI | 1194327478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 061453) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL D.6812-C1) |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2021-01-04 |