| NPI | 1073703419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02314300) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02314300) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2021-04-13 |