| NPI | 1710360854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN27543) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058733) |
| 122300000X Dentist (Licence: CA 103750) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2024-01-17 |