| NPI | 1801243233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02907600) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 060075) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2025-07-16 |