| NPI | 1639329832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PR 2808) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054070) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2013-09-18 |