| NPI | 1710739859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN28962) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI03031400) |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2025-08-02 |