| NPI | 1740355247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 024172) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NY 024172) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-09 |