| NPI | 1245850577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 062383) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11979) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2024-05-26 |