| NPI | 1245649680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02578800) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.24877) |
| 1223G0001X Dentist, General Practice (Licence: NY 057651) | |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2019-12-17 |