| NPI | 1801983887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NV 5870) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 051893) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2010-01-11 |