| NPI | 1124210919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NY NY050049) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: FL DN15647) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |