| NPI | 1215028535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01934400) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NY 0455421) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-10-11 |