| NPI | 1760566921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 042987) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 064061) |
| 1223P0300X Dentist, Periodontics (Licence: NY 042987) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-02-21 |