| NPI | 1083928345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02449500) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI024495) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2022-01-04 |