| NPI | 1609026558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 34816) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50054197) |
| 1223G0001X Dentist General Practice (Licence: NY 50054197) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2021-01-07 |