| NPI | 1851333777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN 013420) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051202) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2013-05-02 |