| NPI | 1518008804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 318268) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: CA A103509) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2023-11-28 |