| NPI | 1639372782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: NY 048076) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 048076) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2012-05-22 |