| NPI | 1942397120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 029199-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 029199-1) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-05-22 |