| NPI | 1376700625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 052238) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 052238) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2024-10-17 |