| NPI | 1417502725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 011036) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 060434-01) |
| Enumeration Date | 2019-08-04 |
| Last Update Date | 2022-02-03 |