| NPI | 1477718401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 56992) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 36354) |
| 1223G0001X Dentist General Practice (Licence: FL 25012) | |
| 1223G0001X Dentist General Practice (Licence: NH 03670) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2022-02-01 |