| NPI | 1194175737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02636800) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02636800) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-09-17 |