| NPI | 1417168824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17707) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 048016) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2025-09-24 |