| NPI | 1699415554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02933600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN27288) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2023-08-10 |