| NPI | 1295896306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 052226) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052226-1) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2016-08-26 |