| NPI | 1265894398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 059575) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02696500) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-08-01 |