| NPI | 1982938544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 000008-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 000008-1) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2009-09-29 |