| NPI | 1952391054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 45998) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 45998) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2009-03-23 |