| NPI | 1851484711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 040158-1) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 27593) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-08 |