| NPI | 1417526443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02855000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61898) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2023-04-05 |