| NPI | 1043626732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02778200) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 059502) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-10-14 |