| NPI | 1992968598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: NY 054539) |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist (Licence: NY 001033) |
| 1223G0001X Dentist General Practice (Licence: NY 054539) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2024-03-22 |