| NPI | 1962529263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 18975) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 18975) |
| 122300000X Dentist (Licence: NY 047597-1) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-07-31 |