| NPI | 1982862850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 051045) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 47666) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2018-01-18 |