| NPI | 1376958876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 058328) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 2.011463) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-07-26 |