| NPI | 1558047704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 000160-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D103042700) |
| 122300000X Dentist (Licence: CT 14244) | |
| 122300000X Dentist (Licence: CA 110297) | |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2025-02-04 |