| NPI | 1326203696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 064587) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MT 1871) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2025-07-16 |