| NPI | 1548539489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D9368) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056577) |
| 1223G0001X Dentist, General Practice (Licence: OR D9368) | |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2021-01-28 |