| NPI | 1972769669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 037586) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 037586) |
| 261QS1200X Clinic/Center, Sleep Disorder Diagnostic (Licence: NY 037586) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY 037586) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NY 037586) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2024-08-18 |