| NPI | 1881746808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 22D102785100) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 051726) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-07-11 |