| NPI | 1265118012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02984100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN28096) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-08-24 |