| NPI | 1982756391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 039529) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN13283) |
| 1223G0001X Dentist, General Practice (Licence: OR D11183) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2020-02-06 |