| NPI | 1265456453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 4218) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 027535) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CT 004218) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2018-10-19 |