| NPI | 1982947651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20449) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057508-1) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-04-25 |