| NPI | 1770994816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 057900) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NJ 22Dl02713301) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2022-03-01 |