| NPI | 1356658942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 058438-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058438-1) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2023-11-28 |