| NPI | 1437147501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21446) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051326) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2020-04-22 |