| NPI | 1740492560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 031064) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 4752) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2024-09-09 |