| NPI | 1992359954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 13969) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02925300) |
| 122300000X Dentist (Licence: IL 019.032304) | |
| 122300000X Dentist (Licence: NY 062241) | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2024-09-03 |