| NPI | 1396709085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 43022) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 43022) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2020-06-10 |