| NPI | 1205858545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 0440831) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NJ 18200) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2008-09-16 |