| NPI | 1275831133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 042499) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24295) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2013-10-02 |