| NPI | 1215415047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ d010229) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA dds102911) |
| 122300000X Dentist (Licence: NY D102911) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2026-04-30 |