| NPI | 1760838288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417363) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02659200) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-05-27 |