| NPI | 1972086684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NY 060478) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02695100) |
| Enumeration Date | 2018-09-09 |
| Last Update Date | 2020-07-07 |