| NPI | 1447593991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS103831) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02530600) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-04-13 |