| NPI | 1982281077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 063580) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS104984) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2023-11-05 |