| NPI | 1528648102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 063804-01) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38240) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-07-11 |