| NPI | 1942490909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 046579) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17425) |
| 1223G0001X Dentist, General Practice (Licence: NY 046579) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2007-07-26 |