| NPI | 1427207588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010018) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 54101) |
| Enumeration Date | 2008-09-14 |
| Last Update Date | 2013-07-15 |