| NPI | 1174698922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 032179) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 32179) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-05-06 |