| NPI | 1417181017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 042733) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 042733) |
| 1223D0001X Dentist, Dental Public Health (Licence: NY 042733) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2009-09-24 |