| NPI | 1972612042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 056555) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN15941) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-09-10 |