| NPI | 1265738074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 058570) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60140) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2022-07-21 |