| NPI | 1689016941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 058224-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA ds039559) |
| 122300000X Dentist (Licence: MA DN1856708) | |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2016-01-18 |