| NPI | 1366766354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 54568) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58830) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2023-08-02 |