| NPI | 1164551115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY NY052458) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052458) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2010-05-05 |