| NPI | 1366652406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 042445-1) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NJ 22DI02988900) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NY 042445) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-09-25 |