| NPI | 1821128448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 11616) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 048822-1) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2016-05-12 |