| NPI | 1013458942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 060465) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857851) |
| 1223G0001X Dentist, General Practice (Licence: TX 35498) | |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2024-08-17 |