| NPI | 1134251556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 034788) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA DDS 39022) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-08 |