| NPI | 1508024787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 056944) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019770) |
| Enumeration Date | 2008-05-24 |
| Last Update Date | 2018-03-12 |