| NPI | 1457731432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ 22D102865200) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 059074) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 059074) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2022-06-30 |