| NPI | 1922336957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053931) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 053931) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2023-03-22 |