| NPI | 1245624584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 047483-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS028864L) |
| 122300000X Dentist (Licence: NJ 22DI018877500) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2022-11-28 |