| NPI | 1649484775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 052507) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY A052507-01) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2023-12-18 |