| NPI | 1982792800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 6480) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 35873) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2023-12-28 |