| NPI | 1437525763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 060568-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857048) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2019-09-19 |