| NPI | 1922145465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 050691-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0059190) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2009-10-01 |