| NPI | 1952306094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 049169) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 049169-1) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2014-07-23 |