| NPI | 1508343930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23322) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02719900) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2021-06-03 |