| NPI | 1659713436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24692) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50056672) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2020-02-12 |