| NPI | 1083966527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 06380501) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61956) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2026-07-10 |