| NPI | 1619455623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059799) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PR 3280) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2022-07-18 |