| NPI | 1841858230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02899900) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032117) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2023-11-11 |