| NPI | 1972768984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D9327) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102363700) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2009-09-18 |