| NPI | 1386809333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 053904) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 053904) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2023-07-17 |