| NPI | 1407109382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 057585) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 25088) |
| 1223E0200X Dentist, Endodontics (Licence: NJ 06350) | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2014-09-18 |