| NPI | 1578852984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15077) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055367-1) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2022-07-21 |