| NPI | 1417621756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NY 064220) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: NC 12403) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2024-09-09 |