| NPI | 1265446819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011086) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 040252-1) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2023-12-13 |