| NPI | 1285787184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 036717) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI den02965) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2011-01-26 |