| NPI | 1669886123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02570400) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 11274) |
| 1223G0001X Dentist, General Practice (Licence: PA DS040012) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2024-05-25 |