| NPI | 1003370750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 000119) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CO AD.0000521) |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401417396) | |
| 1223E0200X Dentist, Endodontics (Licence: TX 37237) | |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2022-01-18 |