| NPI | 1760054969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 065014) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107613) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2025-09-22 |