| NPI | 1699808709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D07771) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 050073) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2011-04-05 |