| NPI | 1497508428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03037100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 064954) |
| Enumeration Date | 2024-04-09 |
| Last Update Date | 2025-10-29 |