| NPI | 1679633325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 2421) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VT 016-0001219) |
| 1223G0001X Dentist, General Practice (Licence: NY 039324-1) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |