| NPI | 1073892246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 055580) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055580-1) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2024-08-22 |