| NPI | 1114158136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY 000003) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 000003) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2009-08-07 |