| NPI | 1609974328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 046156-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA D5031602L) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-10-29 |