| NPI | 1437291077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 041358-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: DE G10000898) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2023-08-24 |