| NPI | 1841356847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN17835) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 7545) |
| 122300000X Dentist (Licence: NY 051240) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2014-04-16 |