| NPI | 1710036009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D7200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051322) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2016-06-29 |