| NPI | 1760405088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NY 051433) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051433) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2019-12-11 |