| NPI | 1619201373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NY 056438) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: NY 000009) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2012-10-11 |