| NPI | 1336823277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02972900) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN28023) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-13 |