| NPI | 1851698815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03296) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02464000) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02464000) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02464000) | |
| Enumeration Date | 2011-02-26 |
| Last Update Date | 2022-08-08 |