| NPI | 1902540081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063411) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02910100) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-11-07 |