| NPI | 1912086372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02320700) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 051732) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2025-07-10 |