| NPI | 1255334165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02183600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 047558-1) |
| 1223G0001X Dentist General Practice (Licence: NJ 22DI02183600) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2022-10-23 |