| NPI | 1891089207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ DI02752200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 057060) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 33687) | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2022-02-07 |