| NPI | 1235175407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 031897) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 031897) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2019-10-15 |