| NPI | 1144873944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859394) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02769200) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02769200) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN1859394) | |
| Enumeration Date | 2019-07-20 |
| Last Update Date | 2022-07-07 |