| NPI | 1063949584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02732600) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 60047) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2024-01-03 |