| NPI | 1336247147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 048178-01) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI017925) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2026-04-29 |