| NPI | 1841963931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 13179) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 115078-01) |
| 122300000X Dentist (Licence: FL DN25993) | |
| 122300000X Dentist (Licence: NJ 22DI02870600) | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2022-05-04 |