| NPI | 1053756205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 057492-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057492-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2019-06-29 |