| NPI | 1801336037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 059409) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16319) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2022-01-17 |