| NPI | 1164511325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 17954) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS027804L) |
| 122300000X Dentist (Licence: NJ 22DI01795400) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2026-04-20 |