| NPI | 1710189261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401004947) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 031624) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2022-10-12 |