| NPI | 1396908943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 100912) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D102435200) |
| 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02435200) | |
| 1223E0200X Dentist, Endodontics (Licence: NY 055815) | |
| 1223G0001X Dentist, General Practice (Licence: MA 22292) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2018-04-09 |