| NPI | 1639752173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063135) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02995400) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2024-01-12 |