| NPI | 1447703889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059971) |
| Additional Taxonomies | 122300000X Dentist (Licence: ZZ 390200000) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-08-20 |