| NPI | 1235878745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02992200) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043641) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2026-04-21 |