| NPI | 1891357281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 13691) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 061425) |
| 1223G0001X Dentist, General Practice (Licence: NY 061425) | |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2024-01-14 |