| NPI | 1942297999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 042029) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC 4394) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2010-11-22 |