| NPI | 1043371461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02258600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054204) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-10-04 |