| NPI | 1780850842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053108) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17714) |
| 1223G0001X Dentist, General Practice (Licence: CT 009702) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2010-02-12 |