| NPI | 1538210638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 009649) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 047646) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2021-02-22 |