| NPI | 1770902181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 001230) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058992) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2024-01-18 |