| NPI | 1861934994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN22175) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02656300) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2020-05-19 |