| NPI | 1467568733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 45022) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 000067) |
| 1223G0001X Dentist, General Practice (Licence: NY 45022) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: NY 45022) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2026-02-16 |