| NPI | 1386053338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 058364-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0101414457) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2023-08-04 |