| NPI | 1497908966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY p64455) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY p64455) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2009-07-31 |