| NPI | 1528284445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 025379) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 026909DDS) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2025-09-11 |