| NPI | 1801940150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 023181-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 3616) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2019-08-27 |