| NPI | 1780044529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 064955) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102623600) |
| Enumeration Date | 2016-03-06 |
| Last Update Date | 2025-08-04 |