| NPI | 1609934744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 046584) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 8871) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-05-05 |