| NPI | 1760785323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 79000049) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 79000049) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2014-05-14 |