| NPI | 1134384597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NJ DI02490100) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS037346) |
| 1223E0200X Dentist, Endodontics (Licence: NC 7782) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2011-12-28 |