| NPI | 1932940798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 064891) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2026-01-28 |