| NPI | 1629103486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT ct 7481) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 041599) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2026-05-08 |