| NPI | 1689299174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02799300) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24856) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2020-06-24 |