| NPI | 1457668279 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 043896) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 043896) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |