| NPI | 1538785860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02862400) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 064483) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2026-03-20 |