| NPI | 1396400701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063132) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03000001) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2026-04-09 |