Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 26804 | NY |
NPI | 1003938424 |
---|---|
Provider Name | Dr. Michael David Altman |
First Address | Tonawanda, NY 14150-9478 |
Second Address | Tonawanda, NY 14150-9478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 08/07/2007 |