| NPI | 1639738222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062870) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02757200) |
| 122300000X Dentist (Licence: PA DS042228) | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2022-11-18 |