| NPI | 1487864120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 039860-1) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 039860-1) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-11-07 |