| NPI | 1407406218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN24746) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 060421) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2023-09-12 |