| NPI | 1780893511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D010825) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 045273) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2021-12-06 |