| NPI | 1407292741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 058389-1) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401413977) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2016-10-24 |