| NPI | 1619551702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02847500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 062777) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2024-10-05 |