| NPI | 1891338224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 062504) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 17165) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 14357) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2025-05-12 |