| NPI | 1538179528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 9654) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 0382050) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2016-12-20 |