| NPI | 1295830438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN10219) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI03008600) |
| 1223G0001X Dentist, General Practice (Licence: NY 063744) | |
| 1223G0001X Dentist, General Practice (Licence: CT 13934) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-03-13 |