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 |