| NPI | 1164080859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI03061100) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1858283) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 063180) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 13813) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2024-08-22 |