| NPI | 1467644062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 029913) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 00014) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2007-08-16 |