| NPI | 1528021169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NJ 021184) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: NJ 5283) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2016-06-08 |