| NPI | 1396114401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 059134) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ Di02618100) |
| 1223E0200X Dentist, Endodontics (Licence: CA 105662) | |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2021-04-12 |