| NPI | 1952931222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02842500) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 062360) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2024-01-14 |