| NPI | 1235989088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401419378) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03035600) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2025-07-07 |