| NPI | 1659691764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19564) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055663) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2016-03-28 |