| NPI | 1144996414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 123415579921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02863400) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2024-11-05 |