| NPI | 1922627868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062117) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 062117) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2022-02-10 |