| NPI | 1457092876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 063212) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 063212) |
| 1223G0001X Dentist, General Practice (Licence: FL DN27631) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2024-02-21 |