| NPI | 1225413297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 058436) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058436) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2024-08-22 |