| NPI | 1174841878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 065365) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 13930) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2026-04-06 |