| NPI | 1760637854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NJ DI02539900) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037627) |
| 1223E0200X Dentist Endodontics (Licence: PA DS037627) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2013-07-22 |