| NPI | 1568659142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 048251) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS031380L) |
| 1223G0001X Dentist, General Practice (Licence: NY 048251) | |
| 122300000X Dentist (Licence: PA DS031380L) | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2015-07-29 |