| NPI | 1780662379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 040665) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL Dn31310) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2026-04-29 |