| NPI | 1982921920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 3780) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055932-1) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2019-07-25 |