| NPI | 1033301890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 054291-1) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 21600) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: RI 02969) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2017-01-23 |