| NPI | 1083096986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 058702) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 058702) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2019-10-08 |