| NPI | 1669885059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 061026) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CT 11612) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2021-09-03 |