| NPI | 1114595444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17810) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02841700) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN2000224) | |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2024-06-24 |