| NPI | 1013907070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 033320) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 0013148) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2014-03-14 |