| NPI | 1609976216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 037431) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 006450) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2007-07-08 |