| NPI | 1477641256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D6931) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 045921) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-09-07 |