| NPI | 1104958446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: HI 2370) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 050906) |
| 1223G0001X Dentist, General Practice (Licence: NY 050906) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2010-07-14 |