| NPI | 1811475437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 062392) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02830800) |
| 122300000X Dentist (Licence: PA DS041910) | |
| 122300000X Dentist (Licence: NJ NJDCATEMP-037778) | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2023-07-02 |