| NPI | 1316005804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 035093) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14151) |
| 1223G0001X Dentist, General Practice (Licence: CT 10002) | |
| 1223G0001X Dentist, General Practice (Licence: MI 2901022850) | |
| 1223G0001X Dentist, General Practice (Licence: LA 6021) | |
| 1223G0001X Dentist, General Practice (Licence: SC 4288) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN21794) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12010958A) | |
| 1223G0001X Dentist, General Practice (Licence: KY 8559) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-11-17 |