| NPI | 1891418059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 063616) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02918700) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2024-06-03 |