| NPI | 1699829291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN26161) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050148) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-09-08 |