| NPI | 1629708086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063729) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019034525) |
| 1223G0001X Dentist, General Practice (Licence: NY 000124) | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2024-01-19 |