| NPI | 1659411445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28443) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 029410) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2024-03-08 |