| NPI | 1801071774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 9684) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 35529) |
| 1223G0001X Dentist General Practice (Licence: FL HAD52) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2015-10-15 |