| NPI | 1952355208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 046003) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 046003) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY 046003) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2025-07-31 |