| NPI | 1033405832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 064614) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.028596) |
| 122300000X Dentist (Licence: NJ 22DI03088000) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2025-07-01 |