| NPI | 1225325830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 056315-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056315-1) |
| Enumeration Date | 2011-07-03 |
| Last Update Date | 2015-12-14 |