| NPI | 1053487934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 040286) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6381) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2007-07-09 |