| NPI | 1073891271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 55484) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PR 3224) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2020-11-17 |