| NPI | 1598463671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 064224) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN28879) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2024-09-24 |