| NPI | 1881696938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 9068) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 9068) |
| 122300000X Dentist (Licence: NY 49611) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2013-01-25 |