| NPI | 1093987018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22di02366600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053916) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2025-04-02 |