| NPI | 1386663193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 0554631) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS-036813-L) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-08-18 |