| NPI | 1952443525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNF000466) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 037798) |
| 1223G0001X Dentist, General Practice (Licence: SC 27) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2025-01-08 |