| NPI | 1891869814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NY 042834) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01462000) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI01462000) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 042834) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-06-08 |