| NPI | 1710078167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053032) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58164) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2009-07-07 |