| NPI | 1396919775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 032507) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 032507) |
| 1223G0001X Dentist, General Practice (Licence: CT 005907) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2014-03-27 |