| NPI | 1710362546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02777800) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21478) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2023-01-10 |