| NPI | 1992788103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 31155) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 11450) |
| 1223G0001X Dentist, General Practice (Licence: GA 8358) | |
| 1223G0001X Dentist, General Practice (Licence: MD 5814) | |
| 1223G0001X Dentist, General Practice (Licence: VA 4655) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2014-07-21 |