| NPI | 1316452717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7001) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 61008) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2020-12-02 |