| NPI | 1730238593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 016-0002229) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053862) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2016-10-11 |