| NPI | 1699974303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 15139) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054110) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2011-11-15 |