| NPI | 1023730595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 064254) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1859691) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2024-09-09 |