| NPI | 1538210588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 0484051) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 048405-1) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2010-07-14 |