| NPI | 1023219045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01885700) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 045175) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2023-03-07 |