| NPI | 1003292285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21909) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02613700) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2017-02-13 |