| NPI | 1508935438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 50267) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050267) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2021-11-24 |