| NPI | 1548459803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 17732) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 0536081) |
| 122300000X Dentist (Licence: FL DN17732) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2017-03-29 |