| NPI | 1215545322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24969) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02804700) |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2025-05-07 |