| NPI | 1316390362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 058610) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02615200) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2022-01-26 |