| NPI | 1184186066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 07549) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22Di02795400) |
| 122300000X Dentist (Licence: NY 061250) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-08-28 |