| NPI | 1831746411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 06827) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02709100) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2020-07-24 |