| NPI | 1609000363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 054294) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054294) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2016-04-08 |