| NPI | 1972282077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 063370) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02988500) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2023-10-31 |