| NPI | 1265532477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI01878200) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA 7269) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2017-11-16 |