| NPI | 1699351577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MO 2021003596) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 000164) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-10-30 |