| NPI | 1073558631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 049384) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 049384) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2013-07-10 |