| NPI | 1598025249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 57362) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057362) |
| 122300000X Dentist (Licence: NY 057362) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI03119800) | |
| 1223G0001X Dentist, General Practice (Licence: NY 057362) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2025-12-31 |