| NPI | 1932340585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 053555) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 009761) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2009-03-11 |