| NPI | 1770227530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 063574) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02911800) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2024-03-14 |