| NPI | 1215574140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 063403) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 063403) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2025-01-28 |