| NPI | 1144212234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 13613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 036783) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2026-06-26 |