| NPI | 1447803218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03074800) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103855) |
| 122300000X Dentist (Licence: WA DE6114918) | |
| 122300000X Dentist (Licence: NY 064460-01) | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2025-03-21 |