| NPI | 1750814059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 060751) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 103166) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2024-07-11 |