| NPI | 1043466063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NY 054055) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054055) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2020-03-09 |