| NPI | 1821125329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AL 5397) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 053783) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2011-04-05 |