| NPI | 1588983019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02591500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058305-1) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2022-09-13 |