| NPI | 1801051495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VT 016.0133835) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2018-02-22 |