| NPI | 1508343120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02831000) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 061535) |
| 122300000X Dentist (Licence: NH 04436) | |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2024-10-23 |