| NPI | 1851008700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 064944) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI03018900) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2026-04-19 |