| NPI | 1396894630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN29301) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 062467-01) |
| 1223G0001X Dentist, General Practice (Licence: NJ DI19744) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2024-08-19 |