| NPI | 1801441852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062357) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN24436) |
| 1223G0001X Dentist, General Practice (Licence: WI 1002170-15) | |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-12-18 |