| NPI | 1790146538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02819400) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 07372) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 059421) | |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2025-07-24 |