| NPI | 1417436205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02858500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 12267) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2021-09-09 |