| NPI | 1528211794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16268) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 50-053959) |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2018-08-30 |