| NPI | 1861652398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02309100) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 052344-1) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2010-03-02 |