| NPI | 1306006986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 008551) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 047164) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2018-10-23 |