| NPI | 1356545537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 053226) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61247) |
| 1223G0001X Dentist General Practice (Licence: NY 053226) | |
| 1223G0001X Dentist General Practice (Licence: CA 61247) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2015-02-04 |