| NPI | 1659923415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02759700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02759700) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2020-01-14 |