| NPI | 1295990661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 0270501) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 0270501) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-07-24 |