| NPI | 1669204665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 064134) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NY 027079) |
| 1223P0300X Dentist, Periodontics (Licence: NJ 22DI03015600) | |
| Enumeration Date | 2024-08-17 |
| Last Update Date | 2024-08-19 |