| NPI | 1578546164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 047917-1) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 047917-1) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2025-09-11 |