| NPI | 1902237449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 059050-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29491) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2017-08-02 |