| NPI | 1073730933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 051665) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 051665) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2011-11-12 |