| NPI | 1194151571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 064484-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857123) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2025-03-13 |