| NPI | 1003945437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 063826-01) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 8814) |
| 1223G0001X Dentist, General Practice (Licence: WI 5999-015) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2024-07-05 |