| NPI | 1396165684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 058230) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058230) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2018-07-03 |