| NPI | 1659570372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 52409) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 52395) |
| 1223E0200X Dentist, Endodontics (Licence: CT 009663) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2026-09-09 |