| NPI | 1386794501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 38468) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 38468) |
| 1223G0001X Dentist, General Practice (Licence: NY 38468) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2013-08-28 |