| NPI | 1659808012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02640900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02640900) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2021-07-19 |