| NPI | 1073621769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 046207) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 46207) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-07-03 |