| NPI | 1740580059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 054198-1) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: NY 054198-1) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2015-07-10 |