| NPI | 1649406638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 59163) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02397100) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2026-02-13 |