| NPI | 1831689421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02754700) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060665) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2021-12-09 |