| NPI | 1811284318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122193) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02487900) |
| 122300000X Dentist (Licence: NY 056175) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2023-01-30 |