| NPI | 1932412657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 054940-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 18707) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2010-07-22 |