| NPI | 1447242284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 043194) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6240) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2019-03-29 |