| NPI | 1194174144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02703900) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040900) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-04-23 |