| NPI | 1013188242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 052814) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY 52814) |
| Enumeration Date | 2008-03-15 |
| Last Update Date | 2026-08-03 |