| NPI | 1922532480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 060356) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 060356) |
| 122300000X Dentist (Licence: NY 060356) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D14569) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-01-29 |