| NPI | 1073502217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 045560-1) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 045560) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2025-11-26 |