| NPI | 1205511052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NY 047763) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 047763) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2025-11-23 |