| NPI | 1487656526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17422) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 035120) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2015-06-17 |