| NPI | 1578134136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02863700) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 13190) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2023-11-03 |