| NPI | 1184365181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063198) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 063198) |
| 1223P0300X Dentist, Periodontics (Licence: NY 063198) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 063198) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 063198) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 063198) | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-02-21 |