| NPI | 1912455379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 063030) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4504) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2024-10-09 |