| NPI | 1225452279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16437) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02559200) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02559200) | |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2024-10-29 |