| NPI | 1861646747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 054360) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY P65701) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2016-06-16 |