| NPI | 1790739274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: DC DEN1000957) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 052691) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2011-01-28 |