| NPI | 1558026294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI03084400) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 063140) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2025-08-24 |