| NPI | 1326131236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 9784) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 049762) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-03-12 |