| NPI | 1164500542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 030365-1) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ D6065) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-02-09 |