| NPI | 1063813343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NY 057889) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057889) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2022-02-14 |