| NPI | 1598297772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 060923) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022378) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-02-23 |