| NPI | 1205468741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401418308) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02860400) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2024-02-12 |