| NPI | 1639499486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 046758) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 046758) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2014-01-10 |