| NPI | 1205458692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22D10245400) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 061820-01) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2023-01-03 |