| NPI | 1508147190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: DC DEN1001701) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 055711-1) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS040860) | |
| 1223E0200X Dentist, Endodontics (Licence: CA 63468) | |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401413097) | |
| 1223G0001X Dentist, General Practice (Licence: MD 14823) | |
| 1223G0001X Dentist, General Practice (Licence: NY 055711-1) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2023-10-02 |