| NPI | 1285801605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-7834) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003754) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2015-09-30 |