| NPI | 1841338399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17028) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 33124) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2022-03-22 |