| NPI | 1679662902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01056900) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 039798) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-03-22 |