| NPI | 1831322304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL Dn20041) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054494-1) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2014-03-24 |