| NPI | 1922215227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 034364) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 034364) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |