| NPI | 1427785989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02960300) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107726) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2023-04-26 |