| NPI | 1134240286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 050033) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 0500331) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2015-07-12 |