| NPI | 1235873431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02995900) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042395) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS042395) | |
| Enumeration Date | 2022-04-24 |
| Last Update Date | 2025-07-10 |