| NPI | 1497745491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL dn16791) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 049103) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2007-07-08 |