| NPI | 1538779319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062790) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02805600) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2024-02-14 |