| NPI | 1952816233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS102092) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02938300) |
| 122300000X Dentist (Licence: PA DS043038) | |
| 122300000X Dentist (Licence: TX 34938) | |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2025-07-25 |